Spine - 2026-09-07 - Journal Article
A Shorter Surgical Interval May be Associated with Improved Patient-reported Outcomes in Hip-spine Syndrome.
Mathew J, Ng MK, Dalton J, Green W, Baek G, Eichbaum Y, Lee Y, Hitchner M, Vanichkachorn A, Barksdale G, Buzzetta A, Fras T, Venkatesh D, Martinazzi B, Farooqi A, Giakas A, Mastrokostas P, Rihn JA, Kaye ID, Kurd MF, Canseco JA, Hilibrand AS, Vaccaro AR, Schroeder GD, Kepler CK
Topics
Key Takeaway
In hip-spine syndrome, patients treated within 1 year between THA and lumbar fusion showed greater ODI improvement at 12 months (P=0.004) compared to those treated >1 year apart, despite similar final HOOS scores.
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Summary
This retrospective cohort examined whether surgical interval between primary THA and primary lumbar fusion influences PROMs in hip-spine syndrome patients at a single tertiary center. Patients treated within 1 year were more likely to have severe hip OA (P=0.003), receive spine surgery first (P<0.001), and had higher baseline ODI (P=0.034). The <1-year group demonstrated greater ODI improvement at 12 months (P=0.004), while HOOS scores improved in both groups with most patients achieving MCID regardless of interval.
Key Limitation
The <1-year group's greater ODI improvement is confounded by significantly higher baseline ODI scores (P=0.034) and preferential spine-first sequencing (P<0.001), neither of which was controlled in multivariable analysis, leaving interval effect size indeterminate.
Original Abstract
STUDY DESIGN
Retrospective Cohort Study.
OBJECTIVE
This study aimed to: (1) identify demographic differences based on the interval between surgeries; (2) compare differences in perioperative outcomes; (3) determine whether the interval between hip/spine surgery influences patient-reported outcomes (PROMs).
SUMMARY OF BACKGROUND DATA
The presence of concurrent hip and spine disease in hip-spine syndrome creates a unique challenge in surgical decision-making given overlapping disease, with ideal timing between index spine and hip procedures remaining unclear.
METHODS
A retrospective review was performed at a tertiary care center (2002-2025). Patients were included if they had undergone primary total hip arthroplasty and primary lumbar fusion in any sequence with an available 12-month HOOS score. Patients were divided based on the interval between surgery (<1-year and >1-year). Outcomes included patient reported outcomes (PROMs), number of revision surgeries, and time between procedures. Bivariate comparisons were made using t-tests and chi-square tests as appropriate.
RESULTS
179 patients (119>1-year, 60<1-year) were included, with no significant differences in demographics. Patients undergoing surgery within 1-year were more likely to have severe hip osteoarthritis and less likely to have mild disease compared to those whose procedures were greater than 1-year apart(P=0.003). There were no differences in revision rates. Order of surgery was associated with interval between procedures (P<0.001). Patients in the <1-year group were more likely to receive spine surgery first (P<0.001), started off with higher baseline ODI (P=0.034), and showed greater improvement after 12 months (P=0.004). HOOS scores improved in both groups, with most patients achieving MCID regardless of surgical interval.
CONCLUSION
In patients with hip-spine syndrome, those treated within 1-year experienced larger improvements in ODI scores and similar 12-month PROMs compared with those treated more than 1-year part. These findings suggest that there may be a benefit to a shorter interval between surgeries in hip-spine syndrome patients, especially in patients with severe hip osteoarthritis.